Abstract： Objective?To analyze the risk factors for early shunt dysfunction after systemic-pulmonary shunt in order to improve early postoperative outcomes. Methods We retrospectively analyzed the clinical records of 189 patients who underwent systemic-pulmonary shunt in General Hospital of Shenyang Military District between February 2002 and December 2010. There were 87 males and 102 females with their age ranging from 3 months to 50（5.3±6.2）years，and body weight ranging from 3 to 56（17.7±11.0）kg. There were 94 patients with tetralogy of Fallot （TOF） and pulmonary artery stenosis，51 patients with pulmonary atresia （PA） and ventricular septal defect，4 patients with PA and intact ventricular septum，10 patients with functional single ventricle （SV） and pulmonary stenosis（PS），6 patients with SV and PA，6 patients with double outlet right ventricle and PS，8 patients with transposition of the great arteries（TGA） and PS，and 10 patients with TGA and PA. The surgical procedures included central aorto-pulmonary shunt （Waterston） in 105 patients, modified Blalock-Taussig shunt in 61 patients and Melbourne shunt in 23 patients. Results Early postoperative death occurred in 13 patients （6.9%）. There were 12 patients （6.3%） with intra-operative severe hypotension or arrhythmia, 10 patients （5.3%） with postoperative severe low cardiac output, and 10 patients （5.3%） with early shunt dysfunction within the first 24 h postoperatively. Univariate analysis identified low body weight （P=0.027）, shunt size with diameter＜4 mm （P=0.025） and severe intra-operative adverse event （hypotension or arrhythmia with P=0.002） were risk factors for early shunt dysfunction. In multivariate analysis, intra-operative adverse event was an independent risk factor for early shunt dysfunction（P=0.017）. Conclusion Early outcomes after systemic-pulmonary shunt can be significantly improved by preventing intra-operative severe hypotension or arrhythmia and choosing shunt size larger than 4 mm，especially for patients with young age, low body weight, and poorly-developed pulmonary artery.
Objectives To systematically review the efficacy of polytetrafluoroethylene (PTFE) covered stent grafts vs. bare stent grafts in transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials (RCTs) and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients (1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients) were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt (HR=0.38, 95%CI 0.31 to 0.47, P<0.000 01) and survival rate (HR=0.59, 95%CI 0.44 to 0.79,P=0.000 5), lower postoperative complications rate (including gastrointestinal bleeding and refractory ascites) (HR=0.44, 95%CI 0.33 to 0.58, P<0.000 01) and encephalopathy rate (HR=0.76, 95%CI 0.57 to 0.99,P=0.05). Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.